Home > E. Pathology by systems > Urinary system > Kidneys > Wilms tumor

Wilms tumor

Friday 14 November 2003

Digital cases

- Case 54 (HPC:54) : Post-chemotherapy Wilms tumor in Beckwith-Wiedemann syndrome

Localization

- kidney (renal Wilms tumor)
- extrarenal Wilms tumor

  • Wilms tumor in testicular germ cell tumor (15105660)

Macroscopical variants

- solid Wilms tumor
- cystic Wilms tumor
- botryoid Wilms tumor
- post-chemotherapy Wilms tumor

Microscopical variants

- anaplastic Wilms tumor (anaplasia in Wilms tumor)
- Wilms tumor with teratomatous cysts

Epidemiological variants

- Wilms tumor arising in a germ cell tumor (15105660)
- bilateral Wilms tumor (multiple Wilms tumor)
- adult Wilms tumor

Associations

- juxtaposed cystic nephroma and Wilms tumor (10594137)

Predisposition syndrome

- aniridia, WAGR syndrome (WT1 locus at 11p13)
- Drash syndrome (WT1 locus at 11p13)
- Beckwith-Wiedemann syndrome (BWS) (11p15.5)
- trisomy 18 (7700182, 12900902)
- monosomy X (Turner syndrome) (7700182)
- constitutional translocation t(1;7)(q42;p15)

  • with skeletal anomalies (bilateral radial aplasia) (8946193, 1651392)

- constitutional translocation t(7;19)(q11.2;q13.3)

  • with thick corpus callosum, enlarged cisterna magna, normal vermis, thick corpus callosum, micrognathia, small and low-set ears (16193462)

- Fanconi syndrome +/- BRCA2 biallelic mutations (14670928)

Cytogenetics

  • target regions: 1q21, 1q42, 2p25, 5q21, 6q21, 7p13, 7p15, 7q11, 7q36, 11p11, 11p13, 11p15, 12q13, 13q13, 15q21, 16q13, 19q13, Chr.X, Chr.20, 22q12

- constitutional 6q21 rearrangements

- constitutional t(7;19)(q11;q13) (16193462)
- constitutional t(7;13)(q36;q13) (6321191)

- 7p15 rearrangements (PTHB locus)

  • i(7)q
  • constitutional t(1;7)(q42;p15) (8946193, 12618763)
  • interruption of PTHB1

- 11p13 rearrangements (WAGR)

  • constitutional t(2;11)(p25;p13) (12845852)
  • constitutional t(5;11)(q11;p13) (2838157)
  • constitutional t(11;22)(p13;q12) (3754537)
  • del(11)(p11p13) (2550862)
  • aniridia and genitourinary abnormalities

- miscellaneous tumoral translocations

CGH

Gains +1q +6 +7q +8 +12 +13
Losses -11 -16

- Gain of 1q is associated with adverse outcome in favorable histology Wilms’ tumors (11159177)

Allelotyping (LOH)

LOH % Target genes References
1p LOH 9.5% unknown 9669666, 17243164
4q LOH 5% unknown 9669666
6p LOH 6% unknown 9669666
7p31-p14 LOH 3-25 POU6F2 9690521 10646884 15459955
9q22.2-q31.1 LOH - - 15761866
11p13 LOH 17-25% WT1 9669666
11p15.5 LOH 28% H19, P57KIP2 9669666
11q LOH 10% unknown 9669666
16q22 LOH 4%-13% unknown 9669666 12620908
18p LOH 9% unknown 9669666
22q LOH 14% unknown 9669666

- Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology wilms tumor (16129848)

Genic mutations

- germline and somatic mutations of WT1 at 11p13 (mutational inactivation) (10-20% of sporadic tumors)
- somatic mutations of CTNNB1 coding for beta-catenin at 3p22-21 (mutational activation) (14% of sporadic tumors) (10463574, 11103785)

WNT/beta-catenin pathway deregulation (17691963)

Beta-catenin gain-of-function mutations are strongly linked to WT1 loss-of-function mutations in syndromic Wilms tumors, and Wnt/beta-catenin signaling increases androgen receptor mRNA expression and blocks apoptosis in prostate cancers.

Novel downstream target genes activated by Wnt/beta-catenin signaling are emerging from expression profiling in genetically defined classes of Wilms tumors

The WNT/beta-catenin pathway is involved in numerous human cancers. Somatic mutations of the CTNNB1 (beta-catenin) gene have also been detected in a subset of pediatric Wilms tumor.

- CTNNB1 somatic mutations

  • Activation of beta-catenin is a late event in the pathogenesis of nephroblastomas and rarely correlated with genetic changes of the APC gene. (22081130)
  • The strong representation of muscle-related genes in the expression profile of CTNNB1-mutated Wilms tumors corresponded to histologically detectable areas of myomatous cells in these tumors that displayed intense and preferential nuclear beta-catenin antibody staining. (16575872)

- PITX2, APCDD1, and two members of the endothelin axis (EDN3 and EDNRA) are directly activated downstream targets of the WNT/beta-catenin pathway that may enhance proliferation of these tumor cells. (16575872)

- Several upstream inhibitors of WNT/beta-catenin signaling like WIF1 and PRDC were also strongly up-regulated in the CTNNB1-mutated Wilms tumors. (16575872)

- Deregulated genes have been detected in both the retinoic acid and the RAS pathways, such as ATX/ENPP2 and RIS1, suggesting an association between these two pathways with that of WNT. (16575872)

References

- Activation of beta-catenin is a late event in the pathogenesis of nephroblastomas and rarely correlated with genetic changes of the APC gene. Grill C, Sunitsch S, Hatz M, Hauser-Kronberger C, Leuschner I, Hoefler G, Guertl B. Pathology. 2011 Dec;43(7):702-706. PMID: 22081130

- Tamimi Y, Ziebart K, Desaulniers N, Dietrich K, Grundy P. Identification of a minimal region of loss on the short arm of chromosome 1 in Wilms tumor. Genes Chromosomes Cancer. 2007 Jan 22;46(4):327-335. PMID: 17243164

- Wittmann S, Zirn B, Alkassar M, Ambros P, Graf N, Gessler M. Loss of 11q and 16q in Wilms tumors is associated with anaplasia, tumor recurrence, and poor prognosis. Genes Chromosomes Cancer. 2007 Feb;46(2):163-70. PMID: 17099873

- Zirn B, Samans B, Wittmann S, Pietsch T, Leuschner I, Graf N, Gessler M. Target genes of the WNT/beta-catenin pathway in Wilms tumors. Genes Chromosomes Cancer. 2006 Jun;45(6):565-74. PMID: 16575872

- Watanabe N, Nakadate H, Haruta M, Sugawara W, Sasaki F, Tsunematsu Y, Kikuta A, Fukuzawa M, Okita H, Hata J, Soejima H, Kaneko Y. Association of 11q loss, trisomy 12, and possible 16q loss with loss of imprinting of insulin-like growth factor-II in Wilms tumor. Genes Chromosomes Cancer. 2006 Jun;45(6):592-601. PMID: 16518847

Reviews

- Tycko B, Li CM, Buttyan R. The Wnt/beta-catenin pathway in Wilms tumors and prostate cancers. Curr Mol Med. 2007 Aug;7(5):479-89. Review. PMID: 17691963

- Rivera MN, Haber DA. Wilms’ tumour: connecting tumorigenesis and organ development in the kidney. Nat Rev Cancer. 2005 Sep;5(9):699-712. PMID: 16110318

- Dome JS, Coppes MJ. Recent advances in Wilms tumor genetics. Curr Opin Pediatr. 2002 Feb;14(1):5-11. PMID: 11880727

Portfolio

  • Wilms tumor. Macrosocpy.
  • Wilms tumor. Macroscopy
  • Wilms tumor. Epithelial component
  • Wilms tumor. Epithelial component
  • Triphasic Wilms tumor
  • Massive WIlms tumor
  • Caliceal invasion by a Wilms tumor
  • Triphasic Wilms
  • Mesenchymal component with muscular differentiation
  • Mesenchymal component with muscular differentiation
  • Massive Wilms tumor
  • Massive Wims tumor
  • Wilms tumor with hilar extension
  • Wilms tumor with central necrotic cavity
  • Botryoid Wilms tumor
  • Epithelial tubes and undifferentated blastema in Wilms tumor
  • Extracapsular invasion of perirenal fat in massive Wilms tumor
  • Wilms tumor (nephroblastoma) of renal inferior pole
  • Wilms tumor with hilar invasion
  • Ruptured WIlms tumor
  • Ruptured WIlms tumor
  • Ruptured WIlms tumor
  • Post-chemotherapy Wilms tumor
  • Post-chemotherapy Wilms tumor
  • Subcapsular hemorrhage complicating a Wilms tumor
  • Cystic partially differentiated Wilms tumor
  • Solid Wilms tumor (extension in perirenal fat)
  • Small Wilms tumor at the superior pole
  • Small Wilms tumor at the superior pole
  • Cystic Wilms tumor
  • Cystic Wilms tumor
  • Pediatric renal tumor prognostic classification (SIOP, 2002)
  • Wilms tumor staging (SIOP, 2002)